| NPI | 1932762275 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: ID 9871557) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MT MED-PHYS-LIC-114770) |
| Enumeration Date | 2019-04-22 |
| Last Update Date | 2025-08-04 |